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More needed to help people with mental ill health stay in work, says chief medical officer

09 September 2014

More needs to be done to help people with mental illness stay in work, according to chief medical officer (CMO) Dame Sally Davies.

In her annual report on the mental health of the nation, Dame Sally’s report highlighted that about 70 million working days were lost to mental illness last year, which cost to the economy up to £100 billion. Additionally, the number of working days lost to stress, depression and anxiety has increased by 24% since 2009.

To challenge this, Dame Sally has called for the National Institute for Health and Care Excellence to analyse the cost benefit of fast-tracking access to treatment for working people who may fall out of work due to mental illness. Rapid access to treatment could improve people’s chances of staying in work.

In addition, the CMO recommended simple changes to help people with mental illness stay in work by offering flexible working hours and employers making early and regular contact with employees on sick leave.

Other recommendations in the report include:

•75% of people with diagnosable mental illness receive no treatment at all. CMO reinforces calls for parity of funding with the acute sector for mental health services and for waiting time targets for mental health services to be developed by NHS England

•There is a need for greater focus on mental health care for children and young people, as 50% of adult mental illness starts before age 15 and 75% by age 18. Early treatment for young people can help to prevent costly later life problems including: unemployment; substance misuse; crime and antisocial behaviour

•There should be a greater focus on the link between long-term physical conditions and mental illness. People with a chronic physical condition have a 2.6-fold increase in the odds of having a mental illness

•Piloting integrated psychiatry services with primary care and the development of psychiatric expertise in primary care. Dame Sally said this could prevent underlying issues escalating and developing into enduring mental illness.

“The costs of mental illness to the economy are astounding,” said Dame Sally. “Through this report, I urge commissioners and decision-makers to treat mental health more like physical health.

“The WHO [World Health Organization] model of mental health promotion, mental illness prevention and treatment and rehabilitation should be adopted in public mental health in England.

“Anyone with mental illness deserves good quality support at the right time. One of the stark issues highlighted in this report is that 60 to 70% of people with common mental disorders such as depression and anxiety are in work, so it is crucial that we take action to help those people stay in employment to benefit their own health as well as the economy.

“My report has also shown that investment in support for children and young people can help to prevent a multitude of problems in later life. Underinvestment in mental health services, particularly for young people, simply does not make sense economically.”

Report recommendations welcomed

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, welcomed the CMO’s report, including the emphasis on the importance of employment to good mental health. “We endorse the CMO’s call for employment becoming a routine outcome indicator for mental health services – an outcome that has real world relevance and is simple to collect,” he said. “We also agree that more support is needed to keep those who are at risk of losing their jobs from joining the ranks of the long-term sick.”

Mark Winstanley, CEO of Rethink Mental Illness, also welcomed the focus on employment. “For many people with mental illness, having a job can be a crucial part of managing their condition and staying well,” he said. “But often people get very little support to go back to work after a period of mental illness, or to stay in employment. Many employers also assume that if you have a mental health problem, you won’t be able to hold down a job.

“We need to see more specialist help for people with mental illness to go back into the workplace. For example, when people receive early intervention care, their prospects of going back into employment are greatly improved.

“We also need greater understanding among employers of how they can support employees with their mental health. Small workplace adjustments can make a huge difference, and don’t have to cost money – it could just be case of offering people flexible working hours, or allowing them to work from home sometimes. Making a mental health a top priority in the workplace is not only important for people with mental illness, it’s also a good thing for their employers.

“However, it’s also important to remember that for some people with serious mental illness, full-time paid work will simply not be possible. Those people must be supported too, and should not be demonised.”

But some have questioned the CMO’s notion of ‘fast-tracking’ access to treatment for people with mental ill health in work. Jenny Edwards chief executive of the Mental Health Foundation, said: “Whilst we recognise the benefit of good quality work to mental health we are concerned about the suggestion to focus the fast tracking of care on people of working age who are at risk of falling out of work. A health service that is free at the point of delivery should ‘fast track’ all and not discriminate in favour of those who are economically active. We consider that there must be an investment in establishing a suite of evidence based solutions to mental ill health and support mental wellbeing, particularly targeted where there are the greatest inequalities.”